经鼻高流量湿化氧疗与无创正压通气治疗创伤性颈髓损伤合并急性呼吸衰竭的临床治疗对比

Comparison of clinical treatment of traumatic cervical spinal cord injuries with acute respiratory failure treated by high-flow nasal cannula therapy and non-invasive positive pressure ventilation

目的 对比经鼻高流量湿化氧疗(HFNC)与无创正压通气(NPPV)在创伤性颈髓损伤合并急性呼吸衰竭(ARF)患者中的疗效,探讨HFNC在创伤性颈髓损伤中的应用价值.方法 采用前瞻性随机对照研究方法,选取郑州大学第一附属医院2016年5月至2018年1月EICU收治的创伤性颈髓损伤合并ARF常规吸氧不能改善患者,采用随机数字表法将168例患者随机分为HFNC组和NPPV组.比较两组患者的一般资料;观察两组患者治疗1、12、24、48 h后的呼吸频率(RR)、二氧化碳分压(PaCO2)、平均动脉压(MAP)等指标,并比较两组患者对氧疗措施的舒适感、28 d内气管插管率、机械通气时间、ICU住院时间、病死率等.结果 两组患者性别、年龄等一般情况比较差异无统计学意义(P>0.05).HFNC组各时间点RR、PaCO2均低于NPPV组,HFNC组T24、T48时PaCO2显著低于NPPV组,差异有统计学意义(P<0.01);两组患者的氧合指数(PaO2/FiO2)均得到改善,HFNC组T12、T24、T48时明显高于NPPV组(P<0.01);HFNC组舒适度评分优于NPPV组(6.93±0.71 vs 4.29±0.93,P<0.01);与NPPV组比较,HFNC组ICU住院时间及气管插管后机械通气时间差异有显著统计学意义(P<0.01);两组气管插管率及病死率比较无统计学意义(P>0.05).结论 HFNC可明显改善颈髓损伤合并ARF患者的呼吸功能,缩短ICU住院时间,并且舒适度较高,值得临床推广.

Objective To compare the clinical efficacy of high-flow nasal cannula oxygen therapy (HFNC) with non-invasive positive pressure ventilation (NPPV) in patients with traumatic cervical spinal cord injury complicated with acute respiratory failure (ARF). Methods A prospective randomized controlled trial was performed in EICU of the First Affiliated Hospital of Zhengzhou University from May 2016 to January 2018. One hundred sixty-eight consecutive patients with traumatic cervical spinal cord injury complicated with ARF, who did not respond to conventional oxygen therapy, were assigned to the HFNC or NPPV treatment group sequenced by the random number table. The baseline clinical characteristics of randomized participants and respiratory frequency (RR), PaCO2, mean arterial pressure (MAP) at 1, 12, 24, 48 h after treatment were evaluated. Comfortable scale, tracheal intubation rate within 28 d, duration of mechanical ventilation, length of stay in ICU and mortality rate were compared as well. Results There was no significant differences in baseline clinical characteristics, such as sex,age. between the two groups (P>0.05). RR and PaCO2 were lower in the HFNC group at all time point. In addition, the HFNC group had significantly lower PaCO2 than the NPPV group at 24 and 48 h after treatment (P<0.01);Oxygenation index (PaO2/FiO2) was improved in both groups, and the HFNC group had superior oxygenation index than the NPPV group at 12, 24, 48 h after treatment (P<0.01). Furthermore, the HFNC group had better comfort scale (6.93±0.71 vs 4.29±0.93, P<0.01), shorter length of stay in ICU and duration of mechanical ventilation compared to the NPPV group (P<0.01). There was no significant differences in tracheal intubation rate and mortality rate between the two groups (P>0.05). Conclusions In addition to the superior efficacy in improving respiratory function and shortening length of stay in ICU, HFNC was well tolerated by patients with traumatic cervical spinal cord injury complicated with ARF, and could be recommended in clinical practice.